Licensed Clinical Psychologist, Beverly Hills, California

Help for Those who Have Trouble Accessing and Expressing Anger as well as for Those Who Feel Angry Much of the Time

by Susan Axtell, Psy.D.

If you are someone who has difficulty letting people know your angry feelings when you are being mistreated or manipulated, it is important that you learn to express your anger assertively. Some people aren’t even aware of being angry; they’ve learned to suppress angry feelings in the service of keeping the peace, pleasing others, or staying “in control.” Suppressed anger can show up as tension headaches, generalized anxiety, or passive-aggressive behaviors like always being late, among other signs. If this sounds like you it will be important for you to get in touch with your anger, get comfortable having the emotion, and learn how to express it appropriately.

On the other hand, if anger is no stranger to you, and in fact, you feel like you have a problem with anger–that it is excessive or destructive–you will need to take a very different approach. If you feel that frequent angry outbursts and constant simmering irritability leave you drained or negatively impact your relationships, the solution is not to express it more, but to change the internal monologue of distorted thinking and mistaken beliefs that exacerbate the anger. This can be accomplished by learning Cognitive Behavioral Therapy (CBT) techniques from a therapist trained in this type of work. CBT will help you understand how distorted thinking like “Black and White Thinking”–seeing something or someone as all good or all bad–is irrational and leads to extreme feelings. Believing that life should be fair or that you are entitled to have things go your way all of the time (low frustration tolerance) are other examples of cognitive distortions that can cause excessive irritability and anger.

Tips for Anger-Suppressors

*Be willing to let go of people-pleasing all the time.
Open your mind to the idea that you don’t have to be “nice” all of the time to be worthwhile. In fact, appropriately communicating anger to people you care about is an indication that you care enough about the relationship to share your true feelings, rather than withdrawing or acting passive-aggressively.

*Concentrate on working through fears that something terrible might happen if you let your anger out.
Pent-up anger can feel frighteningly intense, but it will not cause you to “go crazy” or “do something terrible.” As you begin to express your anger its intensity will begin to diminish. If you’re worried about the initial explosive potential of expressing your anger, practice some of the “how to express anger appropriately” tips below.

* Work through irrational beliefs about anger.
Many people who are afraid of expressing anger experienced violence in their families and associate anger with violent behavior. Anger does not need to be (and should not be) expressed through violence. It is important to learn to be assertive rather than aggressive when communicating angry feelings, which entails communicating in ways that respects the dignity of the person you are talking to. (See tips for expressing anger appropriately” below.)

*Take a time-out.
If you are really angry, not just mildly frustrated or irritated, it’s best to diffuse some of that energy before facing the person you’re angry at. For example, you can talk to a friend and vent your angry feelings, taking the edge off your anger while organizing your thoughts.
It may also be helpful to write about your angry feelings in a journal to diffuse some of the explosive energy and better ensure that you keep your cool when you confront the person you’re angry with. Similarly, working out at the gym or taking a brisk walk first can make it easier for you to then express your feelings appropriately without losing control.

*Use “I-statements.”
You will be much more effective in communicating your anger (or any strong emotion) when you begin each statement with “I feel” as in “I feel angry when you don’t honor your committments to me.” If you say instead “You make me angry,” you are more likely to elicit defensiveness in your listener. The truth is, other people do not make you angry. Your anger is a reaction to your interpretation of the significance of others’ actions.

*Comment on the other person’s behavior rather than their character.
In other words, it is more appropriate to say “I feel angry when you bail on our plans” than “You are such a flake it really makes me angry!”

Taking the time to learn to experience and express your anger appropriately can only benefit your life, decreasing negative physical effects like headaches in suppressors and sky-high blood pressure in ragers, increasing your sense of effectiveness and control, and contributing to better relationships.

Understanding the Purpose of Anger

by Susan Axtell, Psy.D.

Anger is a normal emotion that can be experienced as various degrees of emotion: irritation, frustration, aggravation, exasperation, rage and fury. Anger can also be expressed differently, depending on the situation, the individual, and the degree to which we are mad. Some people are quick to blow their lid, others seem to tolerate nearly endless irritation before they “explode,” some people rarely exhibit any signs of anger whatsoever.

I’ve had clients tell me that they would like to “get rid of” their anger. I understand this to mean that feeling angry makes them uncomfortable and/or they do not like how they express their anger. I always educate these clients about the importance of anger, and every emotion, for that matter.

Our feelings are like messengers. They provide us important information about ourselves and our environment. Getting rid of a difficult or painful emotion would not be adaptive because it would be like choosing to give up your five senses. Just as we rely on our sight and hearing to provide information allowing us to safely navigate the world around us, we depend on our emotions to clue us in to the climate of our interpersonal (and intrapsychic) worlds.

Experiencing anger lets us know when something is amiss–a relational boundary has been crossed, we have been unfairly treated, or we are not getting what we need in a relationship. While having this emotion feels very uncomfortable to many of us, don’t shoot the messenger! The anger is not the problem. Whatever is causing the anger is the problem. That’s where we need to focus our attention and see what needs to change.

That said, is it possible for anger to become a problem in itself? Absolutely! If you feel surprised or scared by the You that emerges when you are angry, or you find yourself losing your temper on a regular basis, or the people in your life are telling you your anger is a problem for them, then it is a good idea to examine your anger and the ways you express it more closely. The “problem” may be that you do not know how to express your anger appropriately. You may have a low frustration tolerance, which can signal other underlying problems like a mood disorder. Or you may not be attending to the problem that is causing the anger, so it naturally keeps knocking on your door in an attempt to get you to pay attention.

Don’t be so quick to dismiss anger as a “bad” thing. Anger, like each of the emotions, provides an opportunity to get to know ourselves better. This, to me, seems like one of the major tasks (and enjoyable aspects) of living.

See also October’s blog post, Learning to Let Your Anger Work for You.

Everyone has experienced stress at one time or another. It’s impossible to remove stress from your life but you can learn to minimize its effects on you. Understanding the difference between stress and stressors is important. Stressors are the events or issues in your life that cause you stress.

Stressors can be brief and situational, like being stuck in traffic, or more persistent like loss, relationship problems, or economic struggles. Stress is the effect of stressors acting on your life–a temporary rise in blood pressure and heart rate, in the case of a short-lived stressor, or ongoing fatigue, concentration problems, or irritability in cases of prolonged stress. Prolonged stress can also exacerbate preexisting depression or anxiety.

Of course, stress can also affect your physical health. Stress is associated with certain cancers, interfering with your body’s immune response, and contributing to cardiovascular disease.

While you will always encounter stressors, the way you choose to react to those stressors can have a significant impact on how much stress you will experience.

–Working out regularly (getting at least 30 minutes of aerobic exercise 3 to 5 times a week) has been proven to improve mood. It can lessen anxiety and has been shown in studies to be as effective as antidepressants in individuals with mild to moderate depression. But even less intense, less lengthly bouts of exertion have been shown to ease stress, so if you can’t meet this ideal exercise goal, don’t let it stress you out further, just get moving!

–Learn to practice mindful awareness. Activities that emphasize mindfulness by focusing attention, such as Yoga or Mindfulness Meditation, allow you to take your mind off of your worries, providing a much-needed break for mind and body.

–Get enough sleep. Honestly assess your sleep needs (most people need 7 to 9 hours to function well) and then take steps in protecting your bedtime from encroaching demands on your time. Having a firm bedtime and rising the same time every day will go a long way towards alleviating any insomnia your anxiety or depression might be causing too.

–Have sex. Sexual activity releases feel-good hormones like endorphins and oxytocin which can help to balance out a mood that’s negatively impacted by stressors. Plus, physical intimacy with a partner helps strengthen emotional intimacy, which can facilitate a mutually-supportive relationship.

–Make time to do those activities that you enjoy and take your mind off of stressors. Rather than falling into the trap of lounging in front of the TV for hours on the weekend because you feel exhausted from the work week, plan an outing that will recharge your battery–visit the Farmers’ Market or get together with friends–or engage in quietly restorative activities at home, like listening to music or reading a good book. Doing positive things that you enjoy sends an unconscious message to yourself that you are worth caring for and that you deserve to enjoy yourself.

–Talk about it. Expressing your feelings to a friend or loved one can help you figure out solutions to the problem that is causing you stress, and enables you to benefit from emotional support they can offer. If the stressor feels too overwhelming to bring to a friend, find a therapist to help you sort through your feelings and move toward solutions.

–Figure out which aspects of your troubling situation you can control. Sometimes when we find ourselves hit by unforseen and uncontrollable circumstances we fall prey to learned helplessness, a state of mind in which you are no longer able to see the features of the situation that you can shape, but instead hold a global perspective that there is nothing you can do about it. You may not always be able to control what happens to you but you always have control over how you choose to respond to crises.

–Modify your expectations of yourself and others. Having unreasonable standards will only worsen your stress. Try to move away from expecting perfection.

–Play with your kids or pets. This may seem like the last thing you feel like doing, but building a fort with your child or wrestling with your dog can help to put things in perspective again. Kids remind us of the magic of play and petting your canine or feline baby is a proven blood-pressure lowering behavior.

–Don’t forget to breathe! When we are stressed out our breathing tends to become shallow, which can worsen anxious feelings. Practice deep and even breathing. It may be helpful to not focus on breathing deeply at first, but rather becoming aware of your breathing, noticing how many counts long the in breath is and out breath is, and attempting first to make your exhale as long as your inhale. Then try to gently increase the length of the exhale to be double that of the inhale.

Confusing Assertiveness with Selfish Behavior

by Susan Axtell, Psy.D.

Periodically in my practice I notice a theme common to several different cases at once. It seems that lately I find myself exploring with patients the difference between selfishness and self protectiveness, or asserting one’s needs in a relationship.

Many of us harbor a fear of being regarded as selfish. We all know someone who can be described this way and they are generally not that much fun to be around. There’s not a whole lot of reciprocity. At best, all your time spent with this person is focused on them—what they are thinking, what they are feeling, what drama they are in engaged in, what crush they are dizzy from—at worst, your own needs in the relationship with this person are ignored—your thoughts and cares of the moment are not addressed, your preferences get bulldozed, you don’t feel truly seen or heard.

No wonder most of us are concerned about being experienced this way! A fundamental human emotional need is to be liked and to connect with others, and we know we don’t much like or feel truly connected to those who are self-centered, so it makes sense that we would want to avoid this characteristic ourselves.

What’s interesting is how many of us confuse assertiveness or self-protective behavior with being selfish. I used to think that more women than men fall prey to this confusion. Women are socialized to be “nice” and to nurture others, and those who clearly reject this pigeonholing get labeled “hard,” “unfeminine,” and, you guessed it, “selfish.”

It’s becoming clearer to me, however, that many men also struggle with the challenge of appropriately looking out for themselves when necessary. Many men, like women, feel a prohibition against this type of behavior because it runs counter to the “people-pleasing” engrained in them.

Often appropriately assertive behavior is squelched in children because complicated subconscious dynamics cause the parent to experience such behavior as threatening—to the parent’s sense of control, to the sense of cohesion of the family as a unit—or the parent has his or her own confusion around selfishness and assertiveness. Whatever the reason, the message gets sent loudly and clearly (if not explicitly) to the child: “That is selfish, naughty, spoiled behavior and if you continue it you risk losing my love.” Well, this is a very frightening proposition and thus this proscription against assertiveness is powerfully entrenched.

It seems that often it is not until we are much older, and no longer as dependent on our parents emotionally, that we begin to unlearn this association between actually being selfish, and asking for what we need in a relationship. Until we have achieved this distinction in our minds and take the risk to care for ourselves in ways that may, at times, not make others in our lives happy, our people-pleasing will actually hurt us (we are left with unspoken wishes, unmet needs, and a lot of resentment) and our relationships (don’t you think that resentment is going to seep out sometime?). So perhaps a way to ease into breaking out of the people-pleaser role is to realize that you cannot truly please others until you please yourself.

Dr. Axtell wrote the postscript for this popular Tokyopop series

TOKYOPOP announced the release of the popular Japanese shojo manga series Life. Tackling real life subjects of teen angst and self-torment such as cutting, suicide, bullying, and gangs in a candid and honest manner, Life features the work of acclaimed manga-ka Keiko Suenobu and includes a purposeful postscript written by licensed clinical psychologist, Susan M. Axtell, Psy.D.

Ayumu and her best friend, Shii-chan, are studying for their all-important high school entrance exams. Test results come back and Ayumu gets into the high school of her choice while Shii-chan doesn’t! The pain of losing Shii-chan’s friendship is so great that Ayumu starts cutting her wrists for comfort. To compound matters, she then makes a friend that might lead her deeper into a downward spiral.

“Life is about friendships and relationships –how easily they can be shattered and how hard it is to put the pieces back together,” says series editor Julie Taylor. “Ayumu’s struggle and her cycle of self-loathing will ring very true to a lot of girls out there, and I hope the book will show that they’re definitely not alone and that there’s a way out. You go on a real emotional roller coaster with this series. Life is intense, cathartic, and impossible to put down!”

“Life portrays the experience of Ayumu, who is faced with the pressures of teenage life, and is struggling with emotions that sometimes feel too strong for her to handle,” says Dr. Axtell. “She discovers that hurting herself makes her feel better—temporarily, anyway.” Axtell continues: “Most people are learning about self-injury—it may even seem like a fad in some circles, but self-injury is not an effective way of coping.”

Life will be available in April at all major book, comic, video, specialty and music stores nationwide at $9.99

Is the woman you’re seeing going through a really rough patch?
Here’s how to help her through it

By Julie Taylor

When the woman you’re seeing is going through a difficult time — she just got laid off, her beloved dog died — you want to be there for her… right? Right. But what does being there mean, exactly? Is it offering a shoulder to cry on? Giving her advice? Taking her mind off her problems? Turns out it just might be a combination of all of the above. Sure, knowing how to act or what to say can be confusing—after all, women generally handle stress much differently than men. So to help you out, here are the tools you’ll need to help her through a tough time. Use them correctly and this experience can help you move from “seeing each other” to “real relationship” status.

Listen
Simply listening to her problems can be the best gift you can give her, according to Susan M. Axtell, Psy.D, a licensed clinical psychologist in private practice in Beverly Hills, CA. “Make her feel heard and understood,” she advises. “Women need someone to listen to them. They need to vent about a situation and talk it through because they don’t want to keep their pain inside. Throughout history, women have been socialized to emotionally connect with others when times get tough.” Axtell recommends active listening, where you reflect back what you’re hearing. For instance, if she says, “I’m so disappointed in my sister for acting like that,” you could say, “I totally understand your disappointment; I’m really surprised by her behavior, too.” This shows her that you’re hearing what she’s saying and that you’re validating her feelings. “Then put on your empathy hat and say it’s natural for her to react this way,” Dr. Axtell advises. She wants you to assure her that she’s not crazy for feeling angry, upset, confused, disappointed, or whatever.

Be her cheerleader
When Lori Miller, 26, of Austin, TX found out her mother was diagnosed with a terminal illness, she was devastated. “I literally felt like I wanted to die, too,” she recalls. “I felt like there was no way I could get through this. But my guy was the one who picked me up and convinced me that I could survive.” When crisis hits, women’s insecurities often overwhelm them. Many times, their knee-jerk reaction is to think, “I can’t do this.” It’s your job to convince her she can . “Tell her that she can handle this—then help her think of two or three other specific times that she’s survived difficult situations,” says communications expert Laurie Puhn, J.D., author of Instant Persuasion: How to Change Your Words to Change Your Life . These reminders will empower her and boost her confidence.

Don’t try to fix everything
“Guys generally like to fix situations,” says Dr. Axtell, “and when they can’t, they get frustrated.” But she says it’s important — make that imperative — to give yourself an attitude adjustment. “Women don’t need things fixed the way men do. She’s not looking for you to repair what’s wrong—she’s just looking for you to be there for her,” Axtell says. Many times, women need to scream, wallow, cry, or do whatever it takes to process their emotions. Only then will they be able to develop a plan of action or plot their next move. That’s when it’s time to offer help—without telling her what to do. “Say, ‘What can I do to help you?’” advises Puhn. Then listen and follow her cues. What if she says there’s nothing you can do? Puhn suggests asking, “Would you like my suggestions on some things you can try?” To avoid adopting a know-it-all attitude, you can preface your advice with: “This is something that worked for me when I was in a similar situation.”

Help her maintain perspective
When women are stuck in the middle of an ordeal, they can feel like it’s the end of the world. Men are usually more apt to look at the big picture—which is why it’s your job to give her a reality check. “If she missed a big deadline at work and is convinced she’s going to get fired,” Puhn says, “tell her that other people have been in this situation and have escaped unscathed. Give specific examples.” You don’t want to dismiss her problems or appear unsympathetic—you simply want her to see that she will survive this, no matter how bad it gets. That’s what Joseph Franklin, 38, of Tulsa, OK, did when his girlfriend was audited by the IRS: “She was going into total panic mode, so I started listing the people we knew who had been audited and had lived to tell the tale,” he recalls. “We even called a buddy of mine who was audited last year and had actually gotten a refund from the IRS in the end.” Real-world examples like this will remind her that she can indeed weather the storm.

Take her mind off it
When Jamie Horne, 35, of La Crescenta, CA, lost her mother to cancer, her boyfriend was a pro at helping take her mind off her grief. “He would pick me up at work and take me to Disneyland for no reason,” she recalls. “Or he’d bring over some bad 80s movies and popcorn and tell me we were having a movie night.” Pampering and distracting her helps because it shows that someone’s taking care of her needs. Because women are conditioned to be caretakers, it feels wonderful when someone takes care of them for a change. So massage her shoulders. Take her out for Thai food. Buy season one of her favorite show on DVD and watch six episodes straight. Just remember: While it’s fine to distract her from her problems, you should never ignore them. “Taking her mind off her troubles for a little while is an appreciated break,” Dr. Axtell explains, “but if you ignore her problems or get down on her for talking about them, it will seem like you’re avoiding them altogether—which isn’t helpful at all. “

Curb the criticism
Guys are raised to be protectors and solve problems, says Dr. Axtell. Women have a different way of dealing with a crisis, so don’t get bent out of shape if she doesn’t follow your advice. Just because she deals in a different way than you might have, doesn’t mean that you issued bad advice or that she doesn’t respect your opinion. It just means that she followed her own heart—which is never a bad thing. Simply be supportive of her decisions and resist the urge to tell her what she “shoulda/coulda/woulda” done instead. She handled her crisis the way she needed to—all the while drawing strength and courage from the fact that you were by her side. And once you’ve survived this tough time together, the good times ahead, as your relationship blooms, will be even sweeter.

Julie Taylor is a writer and editor in Los Angeles, CA, who contributes frequently to Redbook, Cosmopolitan and other national magazines.

My recent conversation with a friend about movie-star crushes turned into a celebration of some of the most twisted men ever seen on screen. From Viggo in “Eastern Promises” to Christian Bale in “American Psycho,” it turns out that a lot of women love the image of cold, even violent, dudes.

Acting Out Through Actor Crushes
The bad boy is aloof, emotionally unavailable, risk-taking and often an iconoclast — exactly the kind of guy you generally don’t want to be stuck next to at your friend’s party.

As one Lemondrop commenter wrote in Linda Lee’s “Hot for Hollywood” post, “In real life they are almost never as hot as their characters” — endlessly dark and innately bad.

So why do we swoon when we see these jerks on screen? Lusting after the classic bad boy allows us to be a little bad ourselves, says Dr. Susan Axtell, a Beverly Hills psychologist. “That can be particularly alluring for women who suffer the constraints of females’ socialization to be ‘nice’ and ‘good.’”

Do Not Attempt at Home
Such is the allure of movies — living out our fantasies via the celluloid bad boy promises all the excitement, without the headaches and the tissues and the seemingly never-ending conversation. But when art imitates life, the drama is usually uglier than the movie’s ending.

“In real life, dealing with the bad boy is too emotionally taxing,” my friend Melanie proclaims as she reflects on her last five dates — all of whom were products of the straitlaced, nerdy set (a coveted cluster). Like an increasing number of women, she prefers classic nice guys, leaving the Colin Farrell-cum-Johnny Depp types for fictional outings with a bag of popcorn.

Behind the Bad Boy Habit
For women who continually pursue heartbreakers, there’s usually a self-destructive method to their Blockbuster madness: Many women often chase the bad boy knowing, on some level, that they won’t catch him. “That obviates the needs for our perhaps underdeveloped ability to be vulnerable and truly intimate ourselves,” says Axtell.

In Psych 101 terms, commitmentphobic women go out with bad boys so that the relationship won’t work — and then women can blame the dirtbag for its dissolution.

Tell us! Do you have a soft spot for hard-edged men? Do you like rebels in real life, or do you prefer to crush on fictional characters?

The dinner was romantic; the wine was fantastic. But once again picking up the tab for your boyfriend? Far from priceless, say the growing number of chicks who are footing the bill. “Girls earning more than their husbands or boyfriends is the best antidote for domestic violence,” says Brigadier Dr S Sudarsanan, Consultant in Psychiatry, Indraprastha Apollo Clinic, Vasant Kunj.

“But the social construct of men as breadwinners still influences the way some couples interact, and some women struggle with the idea that their guy is not stepping up.” Regardless of the fact that many 20 and 30something females are perfectly capable of paying their way, their annoyance is often more on principle. “We’re more independent than ever, but many women today still want to feel taken care of,” says Susan Axtell, Psy.D., therapist in Beverly Hills, California, US.

John’s a lucky guy…
Okay, hold on. Before we all come off sounding like shallow, money-grubbing girls, who only want to date guys with big bucks, there’s more at play psychologically than simply the amount of cash a dude has in the bank account. “If you’re always leading the charge, you may not feel that you’re cherished or desired,” Axtell says.

Sometimes money can also function as a lightning rod for deeper problems, according to psychologist Christine Whelan, Ph.D. A woman may focus on her guy slacking financially when she feels neglected emotionally or senses that he is not being supportive about her career. The key to addressing the problem, experts agree, is to avoid emasculating your man. Tell him that you value his work and your relationship and need to feel you are both contributing as much as you can—not just in money but in emotional support and caretaking. After that, it’s up to you to decide just how much size (in this case, his paycheck’s) really matters.

What Feminism Means To Me

by Susan M. Axtell, Psy.D.

In many ways psychotherapy and feminism seem like they should go hand in hand. Both are about empowerment, self-understanding and health. Both deal with the negative effects of (patriarchal) society on the psychology of women and men. As a psychotherapist and a feminist, I think about the relationship between these schools of thought on a daily basis.

In western society, men are socialized not to have or express feelings that may appear to detract from their “strength,” such as fear. While many women have a greater sense of the emotional aspects of life due to their need to be attuned to the moods of the dominant group (and their being allowed to have this focus, unlike men), this can become dysfunctional when it results in a hypersensitivity to the moods of others and a simultaneous lack of attunement to, or tendency to undervalue, one’s own feelings. Helping female therapy clients become better attuned to their emotions is in many cases as necessary as helping men to do so — despite the attribution society gives to women of being more “emotional.”

All therapists are aware of these gender-based issues, whether they call themselves feminists or not.

However, while as a psychotherapist I must consider the societal forces that contribute to my clients’ symptoms, internal (psychological) processes are traditionally the primary focus. Although this in and of itself need not be harmful, if I do not consider the sociopolitical context in which my clients’ symptoms develop, I also run the risk of failing to examine the ways in which my values have been shaped by sexism. This is problematic because though therapists are supposed to be neutral, this is an impossibility; even if I do not explicitly reveal my values to my clients, they are revealed in the questions that I ask and don’t ask, etc. Therefore, if I am not aware of the ways in which I have been socialized to hold sexist values, I risk imposing these values on my clients, thereby harming them.

Another challenge I face is reconciling my status as “expert” with my feminist objectives. Proponents of feminist theory believe that the power differential between therapist and client ought to be done away with so as to avoid a paternalistic stance that suggests that the therapist knows more about the client than she knows about herself. While the merit of this is the idea of empowering the client, it is artificial to deny the skills and specialized training of the therapist. Clients request my services precisely because I have skills that they don’t (just as I call a plumber when my pipe bursts because I have no knowledge of plumbing). Furthermore, as a woman, the act of downplaying my skills and knowledge seems antithetical to the principles of feminism. Of course, I want to avoid contributing to my female clients’ oppression. The ideal, then, is to create an environment of collaboration between my client and me — my client possesses a great deal of selfwisdom and an inherent understanding of what is necessary for mental health, and my role is to facilitate the process of discovering this wisdom.

Susan is a psychologist at a nonprofit agency serving the homeless in downtown Los Angeles.